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The possible link between celiac disease and unexplained infertility

April 22, 2014

I saw a lovely 26-year-old woman who has been trying to get pregnant for two years in my office recently. Neither she nor her husband has ever conceived. She was having normal regular periods and frequent unprotected intercourse in the middle of her menstrual cycle. She had no complaints of painful periods or painful intercourse. Her only medical complaint was abdominal bloating, cramps and diarrhea that seemed to be related to stress. She had lost weight recently by exercising and eliminating breads and carbohydrates, and as a result, her bloating also improved.

Trying to figure out why she couldn’t get pregnant, she first visited my office to see if we could get to the root of the issue. But, her examination was normal and a sperm count on her husband was also normal. However, because of her lifelong abdominal cramping, she was sent to her primary physician who performed tests indicating she had celiac disease.

Six months after beginning her treatment, she conceived and delivered a 7 lb. 9 oz. female 41 weeks later. For this patient, getting on the right diet to help manage the symptoms of celiac disease was the answer to her infertility issues.

What is celiac disease?

Celiac disease is an inherited disorder of the small intestine that may be triggered by exposure to gluten, a protein complex found in processed wheat, in the diet. Although many cases are asymptomatic, patients with celiac disease can experience symptoms such as: diarrhea, bloating, abdominal cramps, malabsorption, and weight loss, along with other complications that occur outside of the intestines, including infertility.

Researchers are still unclear on how celiac disease is associated with infertility, but the link could possibly be related to an inflammatory process or nutrient deficiency.

A blood test can easily determine if you have celiac disease if you think you may be at risk.

What is unexplained infertility?

Oftentimes, women who struggle with infertility but the cause is unknown are diagnosed with “unexplained infertility.” Unexplained infertility is defined as the absence of a definable cause for a couple’s failure to achieve pregnancy after 12 months of attempting conception despite a thorough evaluation, or after six months in women 35 and older.

Several recent studies have provided hope for women who have been diagnosed with unexplained infertility, as it could possibly be linked to celiac disease. A report published in Fertility and Sterility in 2010 concluded that celiac disease should be checked in patients with unexplained infertility and anemia.

Also in 2010, a nationwide, population-based study was published in the journal Gut to determine whether celiac disease was associated with infertility. They concluded that women with celiac disease had normal fertility, but their fertility was decreased in the last two years preceding the diagnosis of celiac disease. This may possibly reflect the nutritional elements on successful ovulation.

Studies are still being performed and the medical opinion regarding the association of asymptomatic celiac disease and unexplained infertility is controversial. At the very least, a couple with unexplained infertility could attempt a gluten-free diet or ask their gynecologist for a blood test to determine if the patient may have celiac disease.

If celiac disease is confirmed and the patient conceives, she should continue her gluten-free diet throughout the pregnancy to provide the safest environment for her and baby.

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